Abstract 9884: Neonatal Re-Entrant Supraventricular Tachycardia: Clinical Utility of One Year Trans-Esophageal Pacing and Mid-Term Follow-Up Experience
Introduction: Neonatal SVT resolves in many infants by one year of age, but even with clinical quiescence, the substrate for SVT may unknowingly persist. Trans-esophageal pacing (TEP) is a non-invasive means to evaluate persistence of SVT substrate. We describe our experience with one year follow-up TEP studies for neonatal re-entrant SVT.
Methods: A retrospective chart review was performed for all neonates presenting with SVT between 1998 and 2011. Primary atrial tachycardia was excluded. Follow-up TEP was usually recommended at 1 year for patients followed at our institution who had not experienced recent spontaneous recurrence to assess persistence of SVT substrate.
Results: Neonatal SVT occured in 175 patients (orthodromic reciprocating tachycardia [ORT] 136, atrioventricular nodal re-entrant tachycardia [AVNRT] 30, undetermined 9). The prevalence of congenital heart disease (39 patients) was 16% for ORT versus 47% for AVNRT (p<0.001). TEP and one year follow-up data were available in 105 infants. The SVT substrate persisted beyond 1 year in 51/88 (58%) with ORT and 8/17 (47%) with AVNRT, based on either TEP inducibility (47 patients) or spontaneous recurrence (12 patients) beyond 6 months. Among 47 neonates with WPW, 27 had persistent pre-excitation at follow-up TEP (57%). Of the 20 patients who lost pre-excitation at 1 year follow-up, 16 underwent repeat TEP, and 8 (50%) had inducible ORT. As previously reported, AVNRT was sometimes inducible at follow-up TEP in infants presenting with ORT (5 patients). To date, none of these have experienced spontaneous AVNRT. All 41 patients with no SVT substrate at follow-up TEP remained free of recurrences over a mean post-TEP follow-up of 2.1 years off therapy (range 0.7-9.8 years).
Conclusions: Overall, the substrate for neonatal SVT persisted in over half of infants beyond 1 year, regardless of mechanism. Of note, half of patients who lost pre-excitation continued to have substrate for ORT. Follow-up TEP discerns infants in whom the SVT substrate is resolved from those who may remain susceptible. In this cohort AVNRT was more common in neonatal SVT than previously reported, and more commonly associated with congenital heart disease.
- © 2012 by American Heart Association, Inc.